An alternative approach would be to make it easier for people to buy insurance that isn’t tied to their employment. The existing tax break for employer-provided insurance could be replaced with a tax credit that applies to insurance purchased either inside or outside the workplace. At the same time, state mandates that require insurers to cover certain conditions, which make it expensive to offer individual policies, could be removed.

These two reforms would address most people’s anxieties about the health care system. Insurance would be more affordable, especially for people who cannot get it through an employer, so the number of people with insurance would rise.

While the employment-based insurance has problems (i.e. when you lose your job, you lose your insurance), it does allow for increased bargaining power when facing insurance companies. But Ponnuru would ditch that, with the result that insurance companies could charge individuals more. His solution to higher insurance costs is to reduce coverage.

There's your conservative insurance plan: Whatever you can afford. In fact, you already have insurance of a sort. Only got ten dollars to spend? Well, your insurance is, effectively: aspirin, cough syrup, bandages, and maybe some vitamins. Congratulations, you're insured. As is everyone else on the planet.

You forgot to mention all of the people who would not be insured (under this type of plan) because of a pre-existing conditions. Some insurance companies would exclude fertile woman because they could become pregnant and that's expensive.

Conservative who believe that the profit motive is the solution to everything conveniently forget that there are always winners and losers. Someone has to be the loser. But no one wants to be the loser when health care is involved.

That worked for me until 2001, when I was diagnosed with focal segmental glomerulosclerosis. Back then, a CT scan cost somewhere in the neighborhood of $950, and I had to have two of them, and an ultrasound, and a kidney biopsy. I'd have gone broke without health insurance. Social Darwinists like Ramesh Ponnuru couldn't care less about poor people getting decent health care.

I don't know what you are talking about with "increased bargaining power." Every job I've ever had with health insurance was a "take it or leave it" proposition. I have never had an employer with any interest in trying to negotiate health care.

On the other hand, losing my insurance when I lost my job was a very noticable problem. After a hospitalization I wound up with thousands of dollars worth of medical bills that I still haven't been able to fully pay back.

The main reason that employer-based health care is so much cheaper is that the insurance companies get a special perk. They get to kick you off the insurance rolls when you lose your job because it instantly becomes unaffordable. People often lose their job when they become sick and cannot work. Then they lose their health insurance, and due to the special "cozy deal" between the insurance industry and employers, the insurance company gets to drop you. The ability to drop people who are too sick to work drastically lowers the cost of insurance, when the insurance companies can effectively tie insurance to employment.

You are simply on the wrong side of the issue. It should be illegal to tie insurance to employment.